Dental enamel around fixed orthodontic appliances after fluoride varnish application.

Braz Dent J. 2007;18(1):49-53

Authors: Gontijo L, Cruz Rde A, Brandão PR

Poor oral hygiene has been considered one of the main problems routinely faced in the orthodontic treatment. Orthodontic appliance creates an environment that provides mineral loss from the dental enamel. Such condition is clinically seen as white spot lesions and cavitations in the most severe cases. The aim of this study was to evaluate the effects of a fluoride varnish application as a caries prevention method for clinical orthodontics. The experiment analyzed dental enamel adjacent to orthodontics accessories after treatment. In addition, it was observed the calcium, phosphorus and fluoride contents on enamel treated with a fluoride varnish. The results showed that fluoride varnish application is a simple and fast technique that could be useful in preventing enamel demineralization associated to orthodontic treatment. Scanning electron microscopy revealed significant amount of calcium fluoride-like material deposited on enamel and energy dispersive x-ray analysis demonstrated a large incorporation of calcium and fluoride to the enamel of the treated specimens. It was concluded that fluoride varnish could indeed be considered an efficient preventive method to enhance enamel resistance against the cariogenic challenges during orthodontic therapy.

PMID: 17639201 [PubMed - indexed for MEDLINE]

Initial pulp changes during orthodontic movement: histomorphological evaluation.

Braz Dent J. 2007;18(1):34-9

Authors: Santamaria M, Milagres D, Iyomasa MM, Stuani MB, Ruellas AC

This study evaluated pulp changes in molars of rats submitted to tooth movement by application of a 0.4 N force. Twenty-five adult male Wistar rats (Rattus norvegicus, albinus) were randomly assigned to 5 groups (n=5), being one control group not submitted to force application, and four study groups of 6, 12, 24 and 72 h of force application. The study groups received a 5-mm long nickel-titanium closed coil spring, placed from the right maxillary first molar to the maxillary incisors of each animal. The coil spring was used for mesial inclination of the first molar. After the specific period of tooth movement of each study group, the animals were sacrificed and specimens containing the teeth submitted to movement were processed and stained with hematoxylin and eosin for histological analysis under light microscopy. The results demonstrated alteration of the odontoblastic layer, with hypertrophy of odontoblasts especially at the mesial area of the coronal pulp, edema of the pulp connective tissue in the central area of the pulp, and vascular alteration with accumulation of erythrocytes and leukocytes inside the vessels, especially at the mesial root of the moved teeth. These changes were less remarkable for the 72-h period. Thus, it may be concluded that tooth movement yielded pulpal tissue alterations compatible with an inflammatory process, which are reversible if the aggression is not more intense than the physiological limit of tissue tolerance.

PMID: 17639198 [PubMed - indexed for MEDLINE]

Ultrasound bone cutting for surgically assisted rapid maxillary expansion under local anesthesia. Preliminary results.

Minerva Stomatol. 2007 Jun;56(6):359-68

Authors: Robiony M, Polini F, Costa F, Zerman N, Politi M

Surgically assisted rapid maxillary expansion (SARME) is a well-established therapy for correction of maxillary transverse deficiency in adults, when consolidation of sutures has just been completed. It can be performed either under general or under local anesthesia and it can be accomplished with many surgical techniques. One of the most critical steps of SARME is the detachment of the pterygo-maxillary junction, due to the risks connected to such procedure. When required to obtain specific expansion patterns, the pterygo-maxillary separation has been suggested until now only for interventions under general anesthesia, due to the dangerousness and the rawness of this surgical step in awake patients. The authors introduce the use of an ultrasonic bone-cutting device to perform all osteotomic steps of SARME under local anesthesia on an outpatient basis, including pterygo-maxillary detachment. This ultrasonic device is unique in that the osteotomic action occurs only when the tool is employed on mineralized tissues, while it stops on soft tissues. It works in a linear pattern of vibration and it allows precise osteotomies without producing any heat damage to osteotomic surfaces and without any dangerous hammer-related stroke. Due to its precision and safety, this device named Piezosurgery, allows patients to undergo all the steps of SARME under local anesthesia, also without hospitalization.

PMID: 17625493 [PubMed - indexed for MEDLINE]

Difference in quality of life according to the severity of malocclusion in Japanese orthodontic patients.

Tohoku J Exp Med. 2007 May;212(1):71-80

Authors: Tajima M, Kohzuki M, Azuma S, Saeki S, Meguro M, Sugawara J

Although quality of life (QOL) assessment is important in dentistry, it has not been fully investigated in orthodontic patients. We investigated the health-related generic QOL (entire body health) and disease specific QOL (oral health) in adult patients with malocclusions at the first visit. One hundred and twenty-seven orthodontic patients and 66 persons with normal occlusion were recruited for the study. The subjects were divided into the three following groups based on their treatment: 61 patients in need of surgical correction (SURG), 66 patients in need of non-surgical correction (NONS), and 66 control subjects with normal occlusion. Their dentofacial morphology was assessed using a specific Severity Score (SS), which was set up originally based on their cephalometric radiographs and their plaster models of arrangement of their teeth. The subjects also completed a generic QOL assessment questionnaire, the SF-36, and two disease-specific QOL instruments. The patients with malocclusions, especially SURG, had lower disease-specific QOL, although the generic QOL was equal to that of control subjects. Furthermore, in patients with the same severity of dentofacial deformities, especially SS 4 and SS 5, the borderline cases of surgical correction and non-surgical correction, there were differences between SURG and NONS in some items of the QOL. The severity of malocclusion evidently plays an important role in patients' choice of treatment, but also QOL appeared to play a significant role. The QOL assessment may contribute to the selection of the best treatment for improving QOL, especially for borderline cases with moderate degrees of orthodontic abnormality.

PMID: 17464106 [PubMed - indexed for MEDLINE]

Cervical pain and headache in patients with facial asymmetries: the effect of orthognathic surgical correction.

Minerva Anestesiol. 2007 May;73(5):281-9

Authors: Corbacelli A, Cutilli T, Marinangeli F, Ciccozzi A, Corbacelli C, Necozione S, Masedu F, Varrassi G

AIM: Facial asymmetries are often associated with cervicobrachial pain and headache. The aim of the study was to evaluate the influence of surgical orthognathic correction of facial asymmetries on the intensity of cervicobrachial pain and headache in the short and long term. METHODS: Thirty-two patients affected by maxillomandibular asymmetries associated with pain referred to occipital, cervical, dorsal and scapulohumeral areas who were undergoing orthodontic surgical correction were enrolled in the study. The pain intensity at rest and on fibromyalgia trigger points was assessed using a 0-10 Visual Analogue Scale (VAS) preoperatively (T(0)) and 5 days (T(1)), 6 months (T(2)) and 12 months (T(3)) after surgery. Functional limitation was evaluated by the same method at T(0),T(2) and T(3). RESULTS: VAS scores at rest were significantly lower at T(1), T(2) and T(3) compared to T0 in every area to which pain was referred. After 12 months (T(3)), pain at rest was completely absent in 23 patients (71.8%) in the occipital region, in 23 patients (71.8%) in the cervical area, in 22 patients (68.7%) in the dorsal area, and in 28 patients (87.5%) in the scapulohumeral area. In the other patients, the pain scores in all areas were < 1 (0.77, 0.83, 0.95, 0.5 in the occipital, cervical, dorsal, and scapulohumeral areas respectively). The VAS at neck fibromyalgia points were significantly reduced at T(1), T(2), T(3) and functional limitation was improved at T(3) and T(4) (P=0.00). CONCLUSION: This study appears to demonstrate the utility of orthognathic surgery when facial asymmetry is associated with cranial-cervicobrachial pain syndrome, presumably through a new musculoskeletal rearrangement of stomatognathic apparatus. Indeed, the surgical correction has resulted in morphological, functional and symptomatic effects.

PMID: 17380104 [PubMed - indexed for MEDLINE]

Treatment of obstructive sleep apnea and hipoapnea syndrome with oral appliances.

Rev Bras Otorrinolaringol (Engl Ed). 2006 Sep-Oct;72(5):699-703

Authors: de Oliveira Almeida MA, de Britto Teixeira AO, Vieira LS, Quint&#xE3;o CC

Obstructive sleep apnea and hipoapnea syndrome (OSAHS) is a disorder that affects about 4% of the adult population, and besides the social problems associated to snoring and extreme day time sleepiness, it is preoccupying since it may cause pulmonary hypertension and cardiac failure. REVIEW AND DISCUSSION: Through a literature review, we discuss the use of oral appliances to treat this condition, in regards of therapy effectiveness and limitations, main clinical symptoms, major occlusal side effects, rate of improvement and patient satisfaction. CONCLUSIONS: We concluded that the use of oral appliances should be a first choice treatment for mild to moderate OSAHS, being dental, joint and muscular discomforts, hypersalivation and xerostomia, the most frequent clinical symptoms, with light occlusal side effects that normally do not bother the patients, with a good degree of improvement and high satisfaction index.

PMID: 17221064 [PubMed - indexed for MEDLINE]

Surgically assisted rapid maxillary expasion: a preliminar study.

Rev Bras Otorrinolaringol (Engl Ed). 2006 Jul-Aug;72(4):457-61

Authors: do Egito Vasconcelos BC, Caubi AF, Dias E, Lago CA, Porto GG

Surgically assisted rapid maxillary expansion is efficient for the treatment of transverse maxillary deficiencies in skeletally mature patients. AIM: To study two techniques for surgically assisted rapid maxillary expansion: with or without pterygoid plate detachment. MATERIAL AND METHODS: A longitudinal cohort study sample including ten patients aged 18-40 years, with a skeletal transverse discrepancy in the maxilla of more than 4 mm. Two groups were established on a randomized basis, five patients in each group, according to the detachment or absence of detachment of the pterygoid plate. Furthermore, osteotomies of the bilateral zygomatic buttress and the intermaxillary suture were done in both groups. The transverse discrepancy was measured in study models, a posterior-anterior cephalometric radiograph evaluated the superior and inferior zygomatic plane and the inter-tuber distance and an occlusal radiograph evaluated the intermaxillary disjunction in the pre-operative period and 30 days post-operatively. A 7-day period of rest was given after corticotomy before starting expansion with quarter turns once a day. RESULTS: There were no statistically significant differences between pre- and post-operative measurements. CONCLUSION: There are few randomized control trials in literature comparing the two techniques for surgically maxillary expansion. Further studies with a larger sample are required.

PMID: 17143423 [PubMed - indexed for MEDLINE]

Biomechanical behaviour of the periodontal ligament of the beagle dog during the first 5 hours of orthodontic force application.

Eur J Orthod. 2006 Dec;28(6):547-52

Authors: J&#xF3;nsdóttir SH, Giesen EB, Maltha JC

The aim of this study was to describe the mechanical behaviour of the periodontal ligament (PDL) in response to loading with different forces for a period of 5 hours. Seven young adult male beagle dogs (age 1.0-1.5 years) were used. After extractions and placement of implants, custom-made appliances on both sides of the mandible were used to measure the displacement of the second premolars. Tooth displacement was measured during 5 hours of force application. Each dog underwent two measurement sessions. One premolar was moved with a force of 100 cN in the first session and with 50 cN in the second. The contralateral premolar was moved with forces of 100 and 300 cN, respectively. Time-displacement curves showed a rapid instantaneous response lasting only a few seconds followed by a slowly decreasing creep displacement. The instantaneous response demonstrated a large individual variability, caused by both a dog and a force effect. Differences in tooth and PDL anatomy and in the orientation of the periodontal fibres are probably important in this respect. The individual variability faded after the first seconds of tooth displacement, when the viscoelastic properties of the periodontal fibres became more pronounced. The force effect was non-linear for the first minute. Higher forces did not lead to proportionally larger displacements. The non-linearity decreased in the second response. The PDL is a complex material that might be considered as a non-linear fibre-reinforced poroviscoelastic material.

PMID: 17101705 [PubMed - indexed for MEDLINE]

Autonomic cardiac modulation in obstructive sleep apnea: effect of an oral jaw-positioning appliance.

Chest. 2006 Nov;130(5):1362-8

Authors: Coruzzi P, Gualerzi M, Bernkopf E, Brambilla L, Brambilla V, Broia V, Lombardi C, Parati G

BACKGROUND: Patients with obstructive sleep apnea (OSA) are characterized by deranged cardiovascular variability, a well-established marker of cardiovascular risk. While long-term treatment with continuous positive airway pressure leads to a significant improvement of cardiovascular variability, little is known of the possibility of achieving the same results with other therapeutic approaches. The aim of our study was to investigate the responses of autonomic indexes of neural cardiac control to another type of OSA treatment based on an oral jaw-positioning appliance. METHODS: In 10 otherwise healthy subjects with OSA (OSA+) and in 10 subjects without OSA (OSA-) we measured heart rate, BP, and indices of autonomic cardiac regulation derived from time-domain and spectral analysis of R-R interval (RRI), before and after 3 months of treatment with the oral device. High-frequency (HF) power of RRI was taken as an index of parasympathetic cardiac modulation, and the ratio between low-frequency (LF) and HF RRI powers as an indirect marker of the balance between sympathetic and parasympathetic cardiac modulation. RESULTS: At baseline, in comparison with OSA- subjects, OSA+ subjects displayed a significantly lower RRI variance (p < 0.02) and reduced HF RRI powers (p < 0.001). After 3 months of treatment with the oral device, the OSA+ group showed a marked reduction in apnea-hypopnea index (p < 0.001), a lengthening in RRI and a significant increase in its variance (p < 0,02), an increased HF RRI power (from 134 +/- 26 to 502 +/- 48 ms2, p < 0.001), and a reduction in LF/HF RRI power ratio (from 3.11 +/- 0.8 to 1.5 +/- 0.5). As a result of these changes, after the 3-month treatment there were no more significant differences between the two groups in these parameters. In both OSA+ and OSA- groups, body weight, heart rate, and BP did not change over time. CONCLUSIONS: Three months of treatment with a specific oral jaw-positioning appliance improves cardiac autonomic modulation in otherwise healthy patients with OSA of mild degree.

PMID: 17099011 [PubMed - indexed for MEDLINE]

Total airway obstruction after maxillomandibular advancement surgery for obstructive sleep apnea.

Anesth Analg. 2006 Nov;103(5):1267-9

Authors: Hogan PW, Argalious M

BACKGROUND: Maxillomandibular advancement surgery is a surgical option for treating obstructive sleep apnea, especially in patients intolerant to, or noncompliant with, continuous positive airway pressure. METHODS: We describe a patient who underwent maxillomandibular advancement surgery, met criteria for tracheal extubation, and subsequently developed total airway obstruction immediately upon extubation. RESULTS: Before extubation, an airway exchange catheter was used and reintubation occurred without difficulty. The patient was brought back to the operating room for evacuation of a hypopharyngeal hematoma, as well as revision and replacement of fractured hardware. CONCLUSIONS: Nasopharyngolaryngoscopy should be performed routinely before extubating these patients to evaluate for pharyngeal edema and hematoma formation. IMPLICATIONS: Maxillomandibular advancement (MMA) surgery is increasingly used as a surgical option in the treatment of obstructive sleep apnea. We report a case of life-threatening airway obstruction after MMA and discuss the etiology of airway compromise after these surgeries.

PMID: 17056967 [PubMed - indexed for MEDLINE]

Orthognathic treatment: how much does it cost?

Eur J Orthod. 2006 Dec;28(6):520-8

Authors: Kumar S, Williams AC, Sandy JR

The aim of this multi-centre retrospective study was to assess the cost, and factors influencing the cost, of combined orthodontic and surgical treatment for dentofacial deformity. The sample, from the south-west of England, comprised 352 subjects (109 males and 243 females) with an age range of 14 to 57 years treated in 11 hospital orthodontic units. Treatment costs were calculated for each subject by combining consumable costs with staff overhead and capital costs. The median total treatment cost was euro 6075.25 (interquartile range: euro 5139.41-euro 7069.68). Out-patient costs comprised 43 per cent. The median orthodontic treatment costs were euro 1456.23 (interquartile range: euro 1283.73-euro 1638.75). Orthodontic costs on average comprised 25 per cent of the total treatment cost. The cost of orthodontics for orthognathic patients in a hospital setting appears to represent excellent value for the state funded National Health Service in the United Kingdom.

PMID: 17041085 [PubMed - indexed for MEDLINE]

Radiographs associated with one episode of orthodontic therapy.

J Dent Educ. 2006 Oct;70(10):1061-5

Authors: Hujoel P, Hollender L, Bollen AM, Young JD, McGee M, Grosso A

Obtaining lifetime diagnostic radiation histories in head and neck cancer studies is often challenging due to the almost universal lack of centralized registries on X-ray utilization in medicine and dentistry. Both the common nature of orthodontics and the young age at which orthodontics typically occurs make it important to quantify what diagnostic radiographs are typically taken during orthodontic therapy. The aim of this study was to assess the number and type of radiographic films associated with one episode of orthodontic therapy in an educational setting. Charts stored in an orthodontic clinic at one academic setting were randomly sampled, and the type and number of radiographic examinations were tallied for the 325 individuals who were in orthodontic therapy for at least one year. Being under orthodontic therapy for one or more years was associated with a median number of seven extra-oral radiographs and twenty-four intra-oral radiographic films. The extra-oral radiographs included three panoramic radiographs and three cephalometric radiographs. Less than 10 percent of the variability was explained by factors such as age, gender, calendar year, surgical orthodontic therapy, and duration of therapy. Head and neck cancer etiology studies should take into account the ionizing radiation during episodes of orthodontic care. The substantial variability in radiographic practices in orthodontics could be reduced by research into clinical utility and by establishing guidelines.

PMID: 17021285 [PubMed - indexed for MEDLINE]

Long-term follow-up of orthodontically treated deep bite patients.

Eur J Orthod. 2006 Oct;28(5):503-12

Authors: Sch&#xFC;tz-Fransson U, Bjerklin K, Lindsten R

The aim of this study was to evaluate the long-term stability of corrected deep bite and mandibular anterior crowding in a sample of 62 subjects (30 patients and 32 controls). The patients began treatment at a mean age of 12.2 years (SD 1.56). The treatment consisted of non-extraction and fixed appliances in 23 subjects and functional appliances in seven. The treatment group was compared with the control group with normal molar occlusion, normal overjet and overbite, no crowding, and without an orthodontic treatment need. The registrations were made on four occasions: before treatment (T1), after treatment (T2), and at two long-term follow-ups (T3 and T4). Four registrations were also made in the control group. All measurements were undertaken on plaster models and lateral cephalograms. Treatment was found to have normalized the overbite and overjet and to have eliminated the space deficiency in the mandibular anterior region. At T4, there was a minor relapse in overbite in the treatment group (mean 0.8 mm). In the control group, the overbite underwent reverse development (bite opening by 0.7 mm) during the same period. The available mandibular incisor space, however, was -0.9 mm in the treatment group and -1.8 mm in the control group. The long-term stability of the treatment results was thus good.

PMID: 17000717 [PubMed - indexed for MEDLINE]

Maxillary third molar position in Class II malocclusions: the effect of treatment with and without maxillary premolar extractions.

Eur J Orthod. 2006 Dec;28(6):573-9

Authors: Janson G, Putrick LM, Henriques JF, de Freitas MR, Henriques RP

The present study compared the number of erupted and functioning maxillary third molars and their mesio-distal angulation in patients with Class II malocclusions orthodontically treated with and without extraction of two maxillary premolars and fixed appliances. For that purpose, the records of 55 patients were selected, which were divided into two groups. Group 1 was treated without extractions and comprised 28 patient records (19 males and 9 females), with a mean age of 19.03 years [standard deviation (SD) = 2.33], treatment time of 2.59 years (SD = 1.08), and follow-up time of 6.48 years (SD = 2.42). Group 2 was treated with extractions and comprised 27 patient records (14 males and 13 females), with a mean age of 19.94 years (SD = 2.87), treatment time of 2.95 years (SD = 1.17), and follow-up time of 5.88 years (SD = 2.96). Analysis of the erupted and functioning maxillary third molars was conducted on the maxillary and mandibular dental casts. The mesio-distal angulations of the maxillary third molars were assessed on panoramic radiographs with the presence of both maxillary third molars. The results demonstrated that the number of erupted and functioning maxillary third molars was statistically greater (P = 0.01) in Class II subjects treated with extraction of maxillary premolars, when compared with those treated without extractions. The patients treated with two maxillary premolar extractions presented significantly smaller third molar mesio-distal angulations, that are more favourable to eruption, than those treated non-extraction.

PMID: 16957059 [PubMed - indexed for MEDLINE]

The use of three-dimensional imaging in orthodontics.

Eur J Orthod. 2006 Oct;28(5):416-25

Authors: Moss JP

The article illustrates the value of three-dimensional imaging of the face and jaws in the diagnosis and treatment of patients. The applications of programs that have been written for the analysis of facial form are also described, including registration and prediction. The use of the Procrustes analysis is demonstrated in groups of children and adults to differentiate between male and female facial morphology. The use of scanning in forensic science is also described. The application of surface shape analysis to groups of monozygotic and dizygotic twins and to family studies to detect those areas that are genetically determined from those areas, which are not, is illustrated.

PMID: 16957057 [PubMed - indexed for MEDLINE]

[Cephalometric study of alterations induced by maxillary slow expansion in adults]

Rev Bras Otorrinolaringol (Engl Ed). 2006 Mar-Apr;72(2):166-72

Authors: Machado J&#xFA;nior AJ, Crespo AN

Maxilla expansion is a procedure that aims at increasing the maxillary dental arch to correct occlusal disharmony. Largely used in children, its efficacy in adults, when craniofacial growth has attained bone maturity, is controversial. AIM: The present study has the objective of evaluating cephalometric modifications resulting from maxilla expansion in adult patients, observing the following linear measurements: facial width, nasal width, nasal height, maxillary width, mandibular width and maxillary molar width. MATERIAL AND METHODS: The sample was composed of 24 frontal teleradiographs, taken before and immediately after the expansions, from 12 male and female patients aged between 18 years and two months and 37 years and eight months. All patients were submitted to slow expansion of the maxillary bones by means of an appliance used in the technique named "dynamic and functional maxillary rehabilitation". Wilcoxon paired statistical test was used for related samples with a 5% significance level. RESULTS: There was a mean increase of 1.92 mm in nasal width and 2.5 mm in nasal height. As regards the linear measurements maxillary and mandibular width, the mean increase was 2.42 mm and 1.92 mm, respectively. A mean increase of 1.41 mm was found for facial width and 2.0 mm for maxillary molar width, alterations which were statistically significant, the mean time was 5.3 months. CONCLUSION: Based on the results obtained, it may be concluded that the use of maxillary expansion induces increase of the facial measurements studied in adults.

PMID: 16951848 [PubMed - indexed for MEDLINE]

Reasons for permanent tooth extractions in Japan.

J Epidemiol. 2006 Sep;16(5):214-9

Authors: Aida J, Ando Y, Akhter R, Aoyama H, Masui M, Morita M

BACKGROUND: There has been no nationwide study in Japan on reasons for extraction of permanent teeth. This survey was aimed to determine the reasons for extraction of permanent teeth in Japan. METHODS: Five thousand, one hudred and thirty-one dentists were selected by systematic selection from the 2004 membership directory of the Japan Dental Association. The dentists selected were asked to record the reason for each extraction of permanent teeth during a period of one week from February 1 through 7, 2005. Reasons for tooth extraction were assigned to five groups: caries, fracture of teeth weakened by caries or endodontics, periodontal diseases, orthodontics, and other reasons. RESULTS: A total of 2,001 dentists (response rate of 39.1%) returned the questionnaires, and information on 9,115 extracted teeth from 7,499 patients was obtained. The results showed that caries and its sequela (totally 43.3%, 32.7% and 10.6%, respectively) and periodontal disease (41.8%) were the main reasons for teeth extraction. Extraction due to caries or fracture was commonly observed in all age groups over 15 years of age, whereas periodontal disease was predominant in the groups over 45 years of age. CONCLUSIONS: Most of the permanent teeth were extracted due to caries and its sequela and periodontal disease. Prevention and care for dental caries for all age groups and periodontal disease for over middle age groups are required.

PMID: 16951541 [PubMed - indexed for MEDLINE]

Normal torque of the buccal surface of mandibular teeth and its relationship with bracket positioning: a study in normal occlusion.

Braz Dent J. 2006;17(2):155-60

Authors: Mestriner MA, Enoki C, Mucha JN

This study evaluated the degree of buccolingual inclination of mandibular tooth crowns relative to torque. For such purpose, mandibular and maxillary stone casts from 31 Caucasian Brazilian adults with normal occlusion, pleasant facial aspect and no history of previous orthodontic treatment were examined. A custom device was developed for measuring the degree of inclination (torque) of bracket slots of orthodontic appliances relative to the occlusion plane, at three bonding height: standard (center of clinical crown), occlusal (0.5 mm occlusally from standard) and cervical (0.5 mm cervically from standard). Except for the mandibular incisors, which presented a small difference in torque from one another (lingual root torque for central incisors and buccal root torque for lateral incisors), the remaining average values are close to those found in the literature. Due to the convexity of the buccal surface, the 1-mm vertical shift of the brackets from occlusal to cervical affected the values corresponding to the normal torque, in approximately 2 degrees in central and lateral incisors, 3 degrees in canines and 8 degrees in premolars and molars.

PMID: 16924345 [PubMed - indexed for MEDLINE]

A modified double pedicle graft technique and other mucogingival interceptive surgeries for the management of impacted teeth: a case series.

Indian J Dent Res. 2006 Jan-Mar;17(1):35-9

Authors: Sunil S, Avinash BS, Prasad D, Jagadish L

Maxillary canine is one of the most common teeth that are impacted. This accounts for 1-2% of all patients who attend orthodontic treatment. The key to achieve maximal eruption of these teeth is their surgical exposure and the role of periodontist in such situations is to provide a functional and satisfactory width of attached gingiva on the labial surface. There are different techniques to surgically expose the impacted teeth, namely--gingivectomy technique, apically positioned flap, closed eruption technique, modified apically positioned flap, double pedicle flap and free gingival graft. Selection of the procedure is dependent on the positioning of the tooth in relation to mucogingival junction and attached gingiva. In the present case series we describe three different techniques for uncovering of impacted teeth, which are apically positioned flap, closed eruption technique and a modified double pedicle graft specially planned for the situation. These procedures when selected diligently using sound selection criteria will create adequate width of attached gingiva which minimizes or eliminates the future mucogingival problems.

PMID: 16900893 [PubMed - indexed for MEDLINE]

A computerized system to conduct the Tweed-Merrifield analysis in orthodontics.

Braz Oral Res. 2006 Apr-Jun;20(2):167-71

Authors: Barreto MB, Fonseca EM, da Cunha AJ

Precision in orthodontic diagnosis can increase the chance of therapeutic success. The objective of this study was to describe the development of a computerized system (prototype), created from a printed table of the Cranial Facial Analysis and Total Dentition Space Analysis with Difficulty Index--Tweed-Merrifield Analysis--in order to aid orthodontic diagnosis. The analysis was transposed from the manual format to the digital format. A user-logical and clear interface was sought for the development of the prototype, consisting of tables and graphs, including automatic, fast and accurate calculations. The result was the immediate visualization of the resolution of the analysis after filling out the fields on the computer. This technological innovation can be a helpful instrument for the orthodontist that favors a more accurate dental-cranial-facial analysis, increases patient safety, orients conduct and may contribute to teaching and research.

PMID: 16878212 [PubMed - indexed for MEDLINE]

The treatment of painful temporomandibular joint clicking with oral splints: a randomized clinical trial.

J Am Dent Assoc. 2006 Aug;137(8):1108-14

Authors: Conti PC, dos Santos CN, Kogawa EM, de Castro Ferreira Conti AC, de Araujo Cdos R

BACKGROUND: The authors compared the efficacy of bilateral balanced and canine guidance (occlusal) splints in the treatment of temporomandibular joint (TMJ) pain in subjects who experienced joint clicking with a nonoccluding splint in a double-blind, controlled randomized clinical trial. METHODS: The authors randomly assigned 57 people with signs of disk displacement and TMJ pain into three groups according to the type of splint: bilateral balanced, canine guidance and nonoccluding. The authors followed the groups for six months using analysis of a visual analog scale (VAS), palpation of the TMJ and masticatory muscles, mandibular movements and joint sounds. They used repeated analysis of variance and a chi(2) test to test the hypothesis. RESULTS: The type of guidance used did not influence the pain reduction, yet both occlusal splints were superior to the nonoccluding splint, on the basis of the VAS. Despite similar outcomes in relation to opening, left lateral and protrusive movements, TMJ and muscle pain on palpation, subjects who used the occlusal splints had improved clinical outcomes. The frequency of joint noises decreased over time, with no significant differences among groups. Subjects in the groups using the occlusal splints reported more comfort. CONCLUSION: The type of lateral guidance did not influence the subjects' improvement. All of the subjects had a general improvement on the VAS, though subjects in the occlusal splint groups had better results that did subjects in the nonoccluding splint group.

PMID: 16873326 [PubMed - indexed for MEDLINE]

The efficacy of traditional, low-cost and nonsplint therapies for temporomandibular disorder: a randomized controlled trial.

J Am Dent Assoc. 2006 Aug;137(8):1099-107; quiz 1169

Authors: Truelove E, Huggins KH, Mancl L, Dworkin SF

BACKGROUND: Treatment recommendations for patients with painful temporomandibular disorders (TMDs) range from conservative treatments such as physiotherapy to aggressive and irreversible treatments such as restorative reconstruction and joint surgery. METHODS: The authors randomized 200 subjects diagnosed with TMD into three groups: usual conservative, dentist-prescribed self-care treatment without any intraoral splint appliance (UT); UT plus a conventional flat-plane hard acrylic splint (HS); and UT plus a soft vinyl (a low-cost athletic mouth guard) splint (SS). Subjects completed questionnaires and clinical examinations at three, six and 12 months. RESULTS: The authors observed no significant differences among the groups in TMD-related pain levels or other common signs and symptoms of TMD at baseline (BL) or at any follow-up. The changes from BL were comparable for all three groups. The authors did not note any significant differences at any follow-up for compliance with study protocols or for occurrences of adverse effects from either splint type. For HS versus SS, there were significant differences in rates of splint use, but these differences were not accompanied by differences in either self-reported symptoms or in clinical findings. CONCLUSIONS: All patients improved over time, and traditional splint therapy offered no benefit over the SS splint therapy. Neither splint therapy provided a greater benefit than did self-care treatment without splint therapy. CLINICAL IMPLICATIONS: These findings suggest that clinicians who treat patients with TMD should consider prescribing low-cost nonsplint self-care therapy for most patients.

PMID: 16873325 [PubMed - indexed for MEDLINE]

The treatment of temporomandibular disorders with stabilizing splints in general dental practice: one-year follow-up.

J Am Dent Assoc. 2006 Aug;137(8):1089-98; quiz 1168-9

Authors: Wassell RW, Adams N, Kelly PJ

BACKGROUND: The authors evaluated temporomandibular disorder (TMD) outcomes in general dental practice one year after treatment with stabilizing splints (SS) or nonoccluding control splints (CS). METHODS: Seventy-two randomly allocated subjects completed initial treatment. The outcomes measures were a pain visual analog scale (VAS), muscle tenderness, temporomandibular joint (TMJ) tenderness, interincisal opening, TMJ clicks and headaches. After initial treatment, 81 percent of the subjects were found to have been treated satisfactorily. The dentists referred the remaining subjects to a dental hospital. At one year, the authors recalled 52 of the original subjects for evaluation. RESULTS: Improvements after initial treatment were maintained at one year for all outcomes, except for TMJ clicking, which returned to pretreatment levels. Eighty-one percent of the subjects rated their treatment as either good or excellent in reducing jaw pain. The authors found that subjects were aware of more of their TMJ clicks than dentists observed at the one-year clinical examination, but most subjects thought their clicking or the associated pain had been reduced. Fifty-five percent subjects had used their splints in the previous six months, but only 31 percent of these had done so daily. There were no significant differences between splint groups. CONCLUSION: At one year, a good response to TMD treatment in general practice had been maintained, but many subjects still had clicking TMJs. CLINICAL IMPLICATIONS: Trained dentists can manage TMD satisfactorily, with only a small proportion of patients needing specialist attention.

PMID: 16873324 [PubMed - indexed for MEDLINE]

Clodronate inhibits PGE(2) production in compressed periodontal ligament cells.

J Dent Res. 2006 Aug;85(8):757-60

Authors: Liu L, Igarashi K, Kanzaki H, Chiba M, Shinoda H, Mitani H

Periodontal ligament (PDL) cells play an essential role in orthodontic tooth movement. We recently reported that clodronate, a non-N-containing bisphosphonate, strongly inhibited tooth movement in rats, and thus could be a useful adjunct for orthodontic treatment. However, it is not clear how clodronate affects the responses of PDL cells to orthodontic force. In this study, we hypothesized that clodronate prevents the mechanical stress-induced production of prostaglandin E(2) (PGE(2)), interleukin-1beta (IL-1beta), and nitric oxide (NO) in human PDL cells. A compressive stimulus caused a striking increase in PGE(2) production, while the responses of IL-1beta and NO were less marked. Clodronate concentration-dependently inhibited the stress-induced production of PGE(2). Clodronate also strongly inhibited stress-induced gene expression for COX-2 and RANKL. These results suggest that the inhibitory effects of clodronate on tooth movement and osteoclasts may be due, at least in part, to the inhibition of COX-2-dependent PGE(2) production and RANKL expression in PDL cells.

PMID: 16861295 [PubMed - indexed for MEDLINE]

RANKL increase in compressed periodontal ligament cells from root resorption.

J Dent Res. 2006 Aug;85(8):751-6

Authors: Yamaguchi M, Aihara N, Kojima T, Kasai K

The ligand receptor activator of NFkappaB (RANKL) plays an important role in osteoclast formation. However, very little is known about the relationship between external apical root resorption during orthodontic treatment and RANKL. We hypothesized that compressive force is responsible for RANKL formation and up-regulation of osteoclastogenesis in periodontal ligament (PDL) cells from patients with severe orthodontically induced external apical root resorption. RANKL and osteoprotegerin (OPG) production, TRAP-positive cells, and resorptive pits were determined. The increase of RANKL and the decrease of OPG were greater in the severe root resorption group than in the non-resorption group. The numbers of TRAP-positive cells and resorptive pits were also increased in the severe root resorption group than in the non-resorption group. These results support the hypothesis that the compressed PDL cells obtained from tissues with severe external apical root resorption may produce a large amount of RANKL and up-regulate osteoclastogenesis.

PMID: 16861294 [PubMed - indexed for MEDLINE]

Orthognathic surgery for occlusal reconstruction of old malunited jaw fracture.

Kobe J Med Sci. 2006;52(3-4):37-47

Authors: Yokoo S, Komori T, Furudoi S, Shibuya Y, Tateishi C, Hashikawa K, Tahara S, Hanagaki H

Old malunited jaw fractures of nine patients who underwent orthognathic surgery for occlusal reconstruction were clinically evaluated. Early surgery on fractures of the jaw is the optimal treatment when due attention must be paid to occlusion. Since occlusal revision surgery subsequent to inaccurate diagnosis and inappropriate surgery is certainly very difficult and often unsuccessful, surgeons need to pay special attention to this situation.

PMID: 16849871 [PubMed - indexed for MEDLINE]

Orthodontics.

J Am Dent Assoc. 2006 Jul;137(7):954-5; author reply 955

Authors: Dumont TD

PMID: 16803820 [PubMed - indexed for MEDLINE]

A thermoplastic mandibular advancement device for the management of non-apnoeic snoring: a randomized controlled trial.

Eur J Orthod. 2006 Aug;28(4):327-38

Authors: Cooke ME, Battagel JM

This randomized, controlled, crossover trial assessed the effectiveness of an adjustable, thermoplastic, mandibular advancement device (MAD), the TheraSnore, in the management of non-apnoeic snoring. Twenty-three adults who had been referred for a MAD wore the appliance in both a non-advanced and advanced position for 4-6 weeks: the starting position of the MAD was randomized. The outcomes were assessed at baseline and after each phase of MAD wear using questionnaires [(Epworth Sleepiness Scale, snoring history, sleep disturbance, side-effects of the appliance) and a visual analogue scale (daytime sleepiness)]. Eleven subjects had overnight sleep studies at baseline and with the appliance in each position to assess snoring frequency (snores/hour), oxygen saturation, and apnoea hypopnoea index. Supine radiographs were used to examine the oropharyngeal airway at baseline and in response to both appliance positions. In comparison with the non-advanced appliance, the advanced MAD reduced the snores per hour from a median of 398 to 17 (P = 0.002). Sleeping partners reported a marked improvement in their own daytime tiredness (P = 0.002) and sleep disturbance (P = 0.001) when the subject wore the active appliance. The most common side-effect was a dry mouth and 64 per cent of subjects considered the appliance bulky. Radiographic analysis revealed significant vertical opening associated with the appliance and small but significant post-lingual changes with protrusion. The results suggest that the advanced TheraSnore MAD is effective in the treatment of snoring in two out of three non-apnoeic snorers, their sleeping partners derive benefits from this form of treatment, and that complaints of bulkiness and dry mouth may to be related to the inherent vertical opening of the TheraSnore.

PMID: 16772315 [PubMed - indexed for MEDLINE]

Is mild dental invagination a risk factor for apical root resorption in orthodontic patients?

Eur J Orthod. 2006 Aug;28(4):307-12

Authors: Mavragani M, Apisariyakul J, Brudvik P, Selvig KA

The purpose of this retrospective study was to assess if dental invagination is a risk factor for root resorption during orthodontic treatment. The sample consisted of 91 patients (32 males, 59 females) with a mean age of 13.1 years (range 9.3-32.1 years) with complete orthodontic records, including periapical radiographs of the maxillary incisors before and after treatment. Forty-nine patients had at least one maxillary incisor invaginated, whilst the remaining 42 patients were free of dental invaginations. Variables recorded for each patient included gender, age, Angle classification, extraction or non-extraction therapy, ANB angle, overjet, overbite, trauma, habits, agenesis, tooth exfoliation, treatment duration, Class II elastics, body-build, general factors, impacted canines, and root form deviation. Crown and root length of the maxillary incisors were measured on pre- and post-treatment long cone periapical radiographs corrected for image distortion. The percentage of root shortening and root length loss in millimetres was then calculated. Most of the invaginated teeth were minor type 1. Statistical analysis revealed no significant difference in the severity of apical root resorption between invaginated and non-invaginated incisors in patients without dental invaginations, nor was the extent of dental invagination related to the severity of apical root resorption. However, invaginated teeth had malformed roots more often than non-invaginated teeth. Dental invagination, and particularly type 1, cannot be considered a risk factor for apical root resorption during orthodontic tooth movement.

PMID: 16763089 [PubMed - indexed for MEDLINE]

Mandibular advancement and obstructive sleep apnoea: a method for determining effective mandibular protrusion.

Eur Respir J. 2006 May;27(5):1003-9

Authors: Dort LC, Hadjuk E, Remmers JE

The objectives of the study were to test the hypotheses that it is possible, during routine polysomnography (PSG), to prospectively identify favourable candidates for mandibular repositioning appliance (MRA) therapy in the treatment of obstructive sleep apnoea (OSA) and to accurately estimate an optimal protrusive distance at which to fabricate the MRA. A series of subjects underwent a remotely controlled mandibular positioner (RCMP) test during PSG monitoring. The ability of the RCMP test to eliminate OSA and the target protrusion at which that occurred was compared with the success of a custom oral MRA in the 33 subjects who completed the protocol. The RCMP test was a success in 15 subjects and a failure in 18 subjects. Appliance therapy was initiated in 38 subjects and completed in 33. MRA therapy was successful at target protrusion in 80% of subjects who had a successful RCMP test and failed in 78% of those who failed the RCMP test. In conclusion the remotely controlled mandibular positioner test outcome demonstrated a statistically significant association with mandibular repositioning appliance outcome. The target protrusion determined during the remotely controlled mandibular positioner test was the effective therapeutic protrusion in subjects with a successful remotely controlled mandibular positioner test.

PMID: 16707396 [PubMed - indexed for MEDLINE]

Orthodontic treatment need in an accredited graduate orthodontic center in north america: a pilot study.

J Contemp Dent Pract. 2006 May 1;7(2):87-94

Authors: Onyeaso CO, BeGole EA

AIM: To assess the objective orthodontic treatment needs of patients treated in an accredited Orthodontic Clinic in North America using a retrospective cross sectional study and the Dental Aesthetic Index (DAI). METHODS AND MATERIALS: One hundred pre- and post-treatment study models were randomly selected from the model storage facility of the clinic. Only the pre-treatment study models were assessed using the DAI. The pre-treatment and post-treatment ages for each case were noted as recorded on the corresponding study models. The range for the pre-treatment age was 10 to 52 years, and from 12 years, 4 months to 54 years for the post-treatment age range. The duration of treatment for each case was calculated by subtracting the pre-treatment age from the post-treatment age (range of treatment duration, 9 to 125 months). Descriptive statistics as well as chi-square statistics were employed to analyze the data. RESULTS: Fifteen cases had normal or minor malocclusions with no treatment or slight need for treatment. Definite malocclusions with treatment highly desirable accounted for 22 cases and severe malocclusion with treatment highly desirable was found in 16 cases. Forty-seven cases had handicapping malocclusion with treatment considered mandatory. While a statistically significant association (p<0.05) was found between duration of treatment and severity levels of malocclusion (DAI scores), the association between pre-treatment age and DAI scores was not significant (p > 0.05). CONCLUSIONS: Eighty-five percent of the study sample needed orthodontic treatment with different malocclusion severity levels, while 47% of the cases qualified for publicly subsidized treatment due to handicapping malocclusions. The association between duration of treatment and DAI score groups (malocclusion severity levels) was found statistically significant. It could be helpful for more clinic-based (demand populations) studies on treatment needs be undertaken across the globe using the DAI, at least for the purposes of comparison.

PMID: 16685299 [PubMed - indexed for MEDLINE]

Evaluation of the centroid method of occlusion for studying mandibular and maxillary growth.

Eur J Orthod. 2006 Aug;28(4):345-51

Authors: Murata S, Nakamura S, Nagahara K

The aim of this study was to evaluate the centroid method of occlusion for studying mandibular growth and development. This novel technique comparatively expresses the direction of growth of the maxilla and mandible as a single unit. The centroid 'G' was geometrically calculated from the triangle Deltaabc, which comprised the palatal, articulare-gnathion (Ar-Gn), and A-B planes. The plane angles and positional relationship of the centroid with the upper first molar was investigated, focusing on differences between genders and malocclusions. Lateral cephalograms were obtained of 26 males and 51 females with a 'normal' Class I occlusion, 216 females with a Class III incisor relationship, and 230 females, all aged >18 years, with a Class II incisor relationship. Bolton standards and Sakamoto's data were used to determine changes in the angle of the palatal plane to the Ar-Gn plane. Non-significant levels of variation were observed in the angle of the palatal plane to the Ar-Gn plane during the developmental period from childhood to adulthood. Among Class I adult subjects, Deltaabc was similar between genders and the centroid G was located near the occlusal surface of the upper first molar. There was no difference in the area of Deltaabc between malocclusion types. The positional relationship of the centroid G with the upper first molar revealed a shift of the centroid mesially and cervically during the transition from Class III to Class I to Class II. These findings indicate that the centroid method can contribute to orthopaedic diagnosis and the planning of treatment strategies.

PMID: 16644852 [PubMed - indexed for MEDLINE]

Herbst/multibracket appliance treatment of Class II division 1 malocclusions in early and late adulthood. a prospective cephalometric study of consecutively treated subjects.

Eur J Orthod. 2006 Aug;28(4):352-60

Authors: Ruf S, Pancherz H

A prospective study of 23 consecutive adult Class II division 1 malocclusion subjects (19 female and 4 male) treated with the Herbst/multibracket (MB) appliance is presented. The skeletal, dental, and facial profile changes were evaluated in addition to the mechanism of Class II correction during the Herbst phase and the settling of the occlusion during the MB phase. The mean pre-treatment age of the subjects was 21.9 years (15.7-44.4 years). Lateral head films in habitual occlusion from before treatment (T1) and after the Herbst (T2) and MB (T3) phases were analysed using standard cephalometrics and the sagittal occlusion analysis. For the standard cephalometrics, normal growth standards were utilized as control parameters. All patients were treated successfully to a Class I occlusal relationship with a normal overjet and overbite. The mandibular variables (SNB and SNPg) showed an angular increase (1.22 and 0.93 degrees, respectively) during T2-T1 followed by an angular reduction (0.40 and 0.23 degrees, respectively) during T3-T2. Compared with normal growth standards, all mandibular parameters were affected favourably by Herbst/MB treatment. Both the skeletal and soft tissue profile convexities were significantly reduced. Over the entire observation period (T3-T1), the largest amount of profile convexity reduction was seen for the soft tissue profile excluding the nose (mean 3.14 degrees). Class II correction was achieved by both skeletal and dental changes: overjet correction by 13 per cent skeletal and 87 per cent dental changes, and molar correction by 22 per cent skeletal and 78 per cent dental changes. In conclusion, on a short-term basis, the Herbst/MB appliance combination was found to be a powerful tool for non-surgical, non-extraction, treatment of Class II division I subjects in early and late adulthood.

PMID: 16644850 [PubMed - indexed for MEDLINE]

Oral applicances for obstructive sleep apnea?

Am Fam Physician. 2006 Mar 1;73(5):801-3

Authors: Cook V, Schooff M

PMID: 16529085 [PubMed - indexed for MEDLINE]

The relationship between cigarette smoking and perceived dental treatment needs in the United States, 1988-1994.

J Am Dent Assoc. 2006 Feb;137(2):224-34

Authors: Dye BA, Morin NM, Robison V

BACKGROUND: Although factors affecting perceived dental treatment needs have been investigated, the effect of smoking status on perceptions of dental needs has not been examined. METHODS: The authors examined data on 13,227 dentate people aged 20 to 79 years from the Third National Health and Nutrition Examination Survey (NHANES III). Information was collected information on sociodemographic characteristics, cigarette smoking, perceived dental treatment needs and other factors during a home interview, and clinical oral health information was collected at a mobile examination center. RESULTS: In univariate analyses, current smokers were more likely than nonsmokers to perceive dental needs in all categories, except for the need for a dental cleaning. Multivariate regression results indicate that current smokers were more likely to report a need for periodontal treatment and dental extractions compared with nonsmokers (odds ratio [OR] = 1.40; 95 percent confidence interval [CI] = 1.05-1.87 and OR = 1.61; 95 percent CI = 1.22-2.14, respectively). The authors found an interaction between smoking and race/ethnicity in models describing the need for teeth to be filled/replaced and for orthodontic/cosmetic work. CONCLUSIONS: Current smokers were more likely to have more perceived dental needs compared with nonsmokers. Practice Implications. These results may be important for the advancement of efforts directed toward tobacco-use cessation programs and to understand factors that could affect dental care utilization.

PMID: 16521389 [PubMed - indexed for MEDLINE]

Interdisciplinary management of anterior dental esthetics.

J Am Dent Assoc. 2006 Feb;137(2):160-9

Authors: Spear FM, Kokich VG, Mathews DP

BACKGROUND: Dental esthetics has become a popular topic among all disciplines in dentistry. When a makeover is planned for the esthetic appearance of a patient's teeth, the clinician must have a logical diagnostic approach that results in the appropriate treatment plan. With some patients, the restorative dentist cannot accomplish the correction alone but may require the assistance of other dental disciplines. APPROACH: This article describes an interdisciplinary approach to the diagnosis and management of anterior dental esthetics. The authors practice different disciplines in dentistry: restorative care, orthodontics and periodontics. However, for more than 20 years, this team has participated in an interdisciplinary dental study group that focuses on a wide variety of dental problems. One such area has been the analysis of anterior dental esthetic problems requiring interdisciplinary correction. This article will describe a unique approach to interdisciplinary dental diagnosis, beginning with esthetics but encompassing structure, function and biology to achieve an optimal result. CLINICAL IMPLICATIONS: If a clinician uses an esthetically based approach to the diagnosis of anterior dental problems, then the outcome of the esthetic treatment plan will be enhanced without sacrificing the structural, functional and biological aspects of the patient's dentition.

PMID: 16521381 [PubMed - indexed for MEDLINE]

Post-treatment development of the curve of Spee.

Eur J Orthod. 2006 Jun;28(3):262-8

Authors: Lie F, Kuitert R, Zentner A

The aim of this study was to investigate the post-treatment development of the curve of Spee (CS) and to predict its post-treatment stability on the basis of cephalometric parameters. Lateral cephalograms and study models of 135 subjects (50 males and 85 females) were taken before orthodontic treatment (T1; 12.0 +/- 1.5 years), at the end of orthodontic treatment (T2; 14.6 +/- 1.5 years), and at least 3 years out of retention (T3; 26.6 +/- 5.0 years); the curve depth (CD), location of the deepest point (LDP) of the curve, and eight cephalometric parameters were assessed. The sample was divided into a treated and an untreated lower arch group. The upper arch was treated in all patients. The sample consisted of 25 per cent Class I, 73 per cent Class II, and 2 per cent Class-III-treated malocclusions. The results showed that the post-treatment CD was frequently unstable and unexpected changes were relatively common. The LDP was displaced distally during T1-T2 and showed mesial relocation during T2-T3. Assessment of potential predictors of the post-treatment changes in CD and LDP using stepwise regression analysis showed that a deep curve at T2 was associated with a decrease of the CD during T2-T3. A combination of distal location of the LDP with proclination of the lower incisors at T2 and extraction treatment was associated with mesial relocation of the LDP during T2-T3. The results also suggest that an optimal CD of about 2.0 mm at T2 was associated with the least amount of post-treatment change.

PMID: 16495374 [PubMed - indexed for MEDLINE]

An application of a splint purposeful resin-bonded fixed partial denture after orthodontic treatment: a case report.

J Contemp Dent Pract. 2006 Feb 15;7(1):141-9

Authors: Bayda&#x15F; B, Denizoglu S

An adult male patient who had lost his maxillary left central incisor seven years ago in a traffic accident presented with a chief complaint about his unaesthetic appearance associated with the loss of his maxillary left central incisor space, a Class III molar occlusion, and an anterior open bite malocclusion due to tongue-thrust swallowing. Fixed orthodontic treatment was rendered following fan-type expansion of the maxilla. A Maryland bridge as a minimally invasive dentistry approach was used as a retention appliance and the patient's aesthetic appearance was restored.

PMID: 16491157 [PubMed - indexed for MEDLINE]

Sagittal jaw position in relation to body posture in adult humans--a rasterstereographic study.

BMC Musculoskelet Disord. 2006;7:8

Authors: Lippold C, Danesh G, Schilgen M, Drerup B, Hackenberg L

BACKGROUND: The correlations between the sagittal jaw position and the cranio-cervical inclination are described in literature. Only few studies focus on the sagittal jaw position and the body posture using valid and objective orthopaedic examination methods. The aim of this study was to test the hypothesis that patients with malocclusions reveal significant differences in body posture compared to those without (upper thoracic inclination, kyphotic angle, lordotic angle and lower lumbar inclination). METHODS: Eighty-four healthy adult patients (with a mean age = 25.6 years and ranging from 16.1 to 55.8 years) were examined with informed consent. The orthodontic examination horizontal overjet (distance between upper and lower incisors) was determined by using an orthodontic digital sliding calliper. The subjects were subdivided in respect of the overjet with the following results: 18 revealed a normal overjet (Class I), 38 had an increased overjet (Class II) and 28 had an reversed overjet (Class III). Rasterstereography was used to carry out a three-dimensional back shape analysis. This method is based on photogrammetry. A three-dimensional shape was produced by analysing the distortion of parallel horizontal white light lines projected on the patient's back, followed by mathematical modelling. On the basis of the sagittal profile the upper thoracic inclination, the thoracic angle, the lordotic angle and the pelvic inclination were determined with a reported accuracy of 2.8 degrees and the correlations to the sagittal jaw position were calculated by means of ANOVA, Scheff&#xE9; and Kruskal-Wallis procedures. RESULTS: Between the different overjet groups, no statistically significant differences or correlations regarding the analysed back shape parameters could be obtained. However, comparing males and females there were statistically significant differences in view of the parameters 'lordotic angle' and 'pelvic inclination'. CONCLUSION: No correlations between overjet and variables of the thoracic, lordotic or the pelvic inclination could be observed.

PMID: 16448563 [PubMed - indexed for MEDLINE]

Nickel in dental plaque and saliva in patients with and without orthodontic appliances.

Eur J Orthod. 2006 Jun;28(3):292-7

Authors: Fors R, Persson M

The aim of this study was to compare the content of nickel in the saliva and dental biofilm in young patients with and without orthodontic appliances. The possible influence of a dietary intake of nickel on recorded nickel levels was examined. Nickel content in unstimulated whole saliva and in dental plaque of 24 boys and girls (mean age 14.8 years) with intraoral fixed orthodontic appliances was compared with 24 adolescents without such an appliance. Sample collection was set up to exclude nickel contamination. Diet intake was recorded for the preceding 48 hours to account for the influence of recent nickel content in food. Saliva and plaque were analysed for nickel content using an electrothermal atomic absorption spectrometric (ETAAS) method. The acidified saliva samples were analysed as Millipore-filtered saliva with filter-retained fractions and plaque following dissolution in acids. No significant difference in nickel content of filtered saliva was found between the test and the control samples (P = 0.607); the median values of nickel content were 0.005 and 0.004 mug/g saliva, respectively. On the other hand, a significant difference was found for the filter-retained fraction (P = 0.008); median values for nickel were 25.3 and 14.9 mug/g, respectively. A significant difference in nickel content between test and control samples was also found in plaque collected at various tooth sites (P = 0.001; median values 1.03 and 0.45 mug/g, respectively). A stronger difference was found when comparing plaque collected from metal-covered tooth surfaces than from enamel surfaces of orthodontic patients. No association could be found between calculated dietary intake of nickel and recorded nickel in the test and control samples. It is concluded that nickel release occurs into the dental plaque and components of saliva of orthodontic patients, a situation that may reflect time dependence of its release from orthodontic appliances into the oral cavity and an aggregation of nickel at plaque sites.

PMID: 16415086 [PubMed - indexed for MEDLINE]

Gastroesophageal reflux diagnosed by occlusal splint tintion.

Med Oral Patol Oral Cir Bucal. 2006 Jan;11(1):E26-8

Authors: Cebri&#xE1;n-Carretero JL, López-Arcas-Calleja JM

The gastroesophageal reflux (GER) disease is a very frequent digestive disorder, mainly characterised by the reflux of the gastric acidic content to the esophage in abnormal quantities. There are different situations that favour this situation but almost in all of them rely an incompetence of the esophagic sphincter. The clinical consequences are many, including oral manifestations. Among all of them the most frequent is the esophagitis followed by symptoms at the pharynx or larynx and finally, the oral cavity. At this level fundamentally we will find enamel and oral mucosa erosions. We report the case of a patient who was indirectly diagnosed of her esophague disease by the observation of the alterations in the occlusal splint induced by the gastric reflux. We review the literature concerning the above topic and its possible association with the miofascial syndrome.

PMID: 16388289 [PubMed - indexed for MEDLINE]

Relationship between substance P and interleukin-1beta in gingival crevicular fluid during orthodontic tooth movement in adults.

Eur J Orthod. 2006 Jun;28(3):241-6

Authors: Yamaguchi M, Yoshii M, Kasai K

Metabolism by peptidases plays an important role in modulating the levels of biologically-active neuropeptides, while that of substance P (SP), a component of gingival crevicular fluid (GCF), may potentiate the inflammatory process in orthodontic tooth movement. The aim of this study was two-fold: (1) to investigate GCF levels of SP and interleukin-1beta (IL-1beta) during human orthodontic tooth movement, and (2) to determine the correlation coefficients between SP and IL-1beta levels in the GCF. The subjects were 3 males, with a mean age of 21.3 +/- 2.8 years old, and 6 females, with a mean age of 23.1 +/- 2.4 years, undergoing orthodontic movement of a single tooth, with the contralateral tooth used as the control. GCF was sampled at the control and treatment (compression) sites before and 1, 4, 8, 24, 72, 120, and 168 hours after initiation of orthodontic treatment. Prevention of plaque-induced inflammation allowed assessment of the dynamics of mechanically stimulated SP and IL-1beta levels in the GCF, which were determined using enzyme-linked immunosorbent assay (ELISA) kits. GCF levels of SP and IL-1beta for the treated teeth were significantly higher (P < 0.001) than for the corresponding control teeth from 8 to 72 hours, and peaked at 24 hours. These results show that the amounts of SP and IL-1beta in GCF increase with orthodontic tooth movement, and indicate that such increases may be involved in inflammation in response to mechanical stress.

PMID: 16373450 [PubMed - indexed for MEDLINE]

Localized sequential use of resilient lining to generate orthodontic force in thermoformed active removable appliances.

J Orthod. 2005 Dec;32(4):235-40

Authors: Ng EW

A new modality of orthodontic treatment based on the thermoformed appliance was developed and trialled clinically. A light-cured resilient lining material commonly used for denture relining was placed locally and sequentially in thermoformed appliances to generate orthodontic forces. The new method appeared to be effective. All the presented cases showed substantial improvement in dental alignment. A number of orthodontic movements were demonstrated. Localized use of resilient lining in thermoformed orthodontic appliances appeared to be a promising alternative to other thermoformed active removable appliance (TARA) treatments. Further studies are required to optimize the procedures and explore its full potential.

PMID: 16333043 [PubMed - indexed for MEDLINE]

Development of a questionnaire for assessment of the psychosocial impact of dental aesthetics in young adults.

Eur J Orthod. 2006 Apr;28(2):103-11

Authors: Klages U, Claus N, Wehrbein H, Zentner A

The aim of this study was to develop a psychometric instrument for assessment of orthodontic-specific aspects of quality of life. The study subjects, 194 young adults aged 18-30 years, were interviewed using a pool of 23 items dealing with the psychosocial impact of dental aesthetics. Self- and interviewer-rating of the dental aesthetic appearance of each subject were carried out using the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN). Additionally, the Perception of Occlusion Scale and a modification of the Dental Aesthetic Index (DAI) were applied. Factorial analyses identified four measures within the item pool, namely Dental Self-Confidence, Social Impact, Psychological Impact, and Aesthetic Concern. The factor structure was confirmed in an independent sample of 83 subjects aged 18-33 years. The reliabilities of the factor analysis-derived scales were between alpha (alpha) 0.85 and 0.91. They differed between respondents with varying severity of malocclusion, as assessed by subject and interviewer ratings. The results suggest that the proposed instrument, termed the 'Psychosocial Impact of Dental Aesthetics Questionnaire' (PIDAQ), meets the criteria of factorial stability across samples and criterion-related validity and reliability, and might be a promising tool for further research and clinical application in orthodontics.

PMID: 16257989 [PubMed - indexed for MEDLINE]

A costs analysis of dental treatment for ectodermal dysplasia.

J Am Dent Assoc. 2005 Sep;136(9):1273-6

Authors: Murdock S, Lee JY, Guckes A, Wright JT

OVERVIEW: Dental treatment modalities for ectodermal dysplasia (ED) vary markedly depending on the clinical manifestations, but to date there have been no studies exploring the potential economic impact of ED. On the basis of anecdotal and clinical reports, the authors postulate that costs of dental treatment for this condition can have a substantial financial impact on patients and their families. OBJECTIVE: The purpose of the authors' pilot study was to develop an economic model for various treatment modalities for ED with severe hypodontia. METHODS: The authors first used a comprehensive review of the literature and expert consensus to establish a treatment modalities model for ED. Next, they completed chart reviews to validate the model with sample treatment and costs information. Using these data, they then constructed a model of treatment options and associated costs. RESULTS: The sample included 24 patients with ED who had severe hypodontia. Forty-two percent were female; patients' ages ranged from 4 years, 11 months to 31 years, 1 month. Forty-two percent had dental insurance coverage, while more than one-half paid for services out of pocket. An estimated 84 percent had undergone prosthodontic treatment, 37 percent orthodontic treatment and 19 percent implant surgery. Depending on the age of the patient and types of dental treatment, there was a broad variation in costs. This ranged from $2,038 to $3,298 for those who had received prosthodontic treatment only; it ranged from $12,632 to $41,146 for those who had received a combination of prosthodontic, orthodontic and implant treatment. CONCLUSIONS: Dental treatment for ED had a marked financial impact on patients and their families and varied depending on the type and duration of treatment.

PMID: 16196232 [PubMed - indexed for MEDLINE]

Effects of mandibular advancement on brain activation during inspiratory loading in healthy subjects: a functional magnetic resonance imaging study.

J Appl Physiol. 2006 Feb;100(2):579-86

Authors: Hashimoto K, Ono T, Honda E, Maeda K, Shinagawa H, Tsuiki S, Hiyama S, Kurabayashi T, Ohyama K

Oral appliances have been a popular treatment option for subjects with obstructive sleep apnea. However, little information is available on how brain activation induced by respiratory challenge is modulated by mandibular advancement with these appliances. We hypothesized that the brain activation caused by respiratory stress may be alleviated by mandibular advancement. Respiratory stress was induced in 12 healthy subjects by resistive inspiratory loading. The effects of mandibular advancement during resistive inspiratory loading were assessed subjectively by using a visual analog scale. These effects were also evaluated objectively by using blood oxygenation level-dependent functional magnetic resonance imaging. The score for the visual analog scale significantly decreased with mandibular advancement. Cortical deactivation, in association with mandibular advancement, was localized to several specific regions, including the left cingulate gyrus and the bilateral prefrontal cortexes. These regions are known to be involved in respiratory control. Our results suggest that mandibular advancement with an oral appliance appears to be useful for reducing respiratory stress, based on both subjective and neuronal criteria.

PMID: 16195387 [PubMed - indexed for MEDLINE]

Patients' motivations for treatment and their experiences of orthodontic preparation for orthognathic surgery.

J Orthod. 2005 Sep;32(3):191-202

Authors: Williams AC, Shah H, Sandy JR, Travess HC

OBJECTIVE: To determine patients' motivations for undergoing orthognathic surgery and their experiences of the orthodontic aspects of this treatment. DESIGN: Retrospective questionnaire survey using a patient-centred measure. SETTING: Thirteen National Health Service (NHS) hospital orthodontic departments. SUBJECTS: Three-hundred-and-twenty-six patients (58% response rate) who underwent orthognathic surgery during the period 1 January 1995 to 30 September 2001 completed a questionnaire. MAIN OUTCOME MEASURES: Motivations for treatment and perception of information about treatment and experiences of orthodontic treatment. RESULTS: Major motivations for treatment were to have straight teeth (80%), to prevent future dental problems (69%) and to improve self-confidence (68%). Females sought treatment to improve self-confidence and their smile. Males wanted treatment to improve their social life. Most of these issues had improved following surgery. Most (94%) respondents felt well-informed about their orthodontics. However, 36% wore braces for longer than they expected. Males and younger patients knew less about the duration of treatment than other groups. Fifty-eight per cent of subjects found their braces difficult to clean and 9% reported that they were very painful. Older patients experienced fewer problems wearing braces than younger patients. CONCLUSIONS: Improving dental appearance and preventing future dental problems are major motivators for orthognathic patients. Although patients felt well informed about what to expect from their orthodontic treatment, a significant proportion, particularly younger patients and males, were surprised at the length of treatment and the need to wear retainers. This suggests that orthognathic patients might benefit from better information regarding the orthodontic aspects of their care.

PMID: 16170061 [PubMed - indexed for MEDLINE]

A 2-year outcome audit of a versatile orthodontic bone anchor.

J Orthod. 2005 Sep;32(3):175-81

Authors: Mommaerts MY, Michiels ML, De Pauw GA

This study examined complications leading to, or possibly leading to, treatment failure, related to the use of the orthodontic bone anchor (OBA). The OBA is a potential means of providing absolute anchorage and consists of a base-plate fixed with mono-cortical screws, a neck piercing the soft tissues, and a coronal part with conventional orthodontic hooks, tubes or slots. The investigation took the form of a single centre prospective registry at a supra-regional teaching hospital. Eighteen patients (average age 21 years) had one to four OBAs placed between January 2000 and February 2002. Altogether 35 OBAs were placed. Follow-up took place until April 2004. Reasons for placing the OBAs were noted together with any associated complications during the follow-up period. Twenty-three OBAs have been removed so far, four prematurely (one of them before it was taken into use, due to a change of treatment plan enforced by loss of the contralateral OBA). Nineteen were removed as planned after completion of the intended tooth movements. Common (but minor) complications included granulations, acute gingivitis and gingival recession. Light mobility of the OBA was also noted in some cases, but without clinical repercussions. The OBA can be loaded directly, at the level of the orthodontic archwire or more occlusally. It can be placed at any site at the circumference of the jaws, given good quality and thickness of the bony wall. Conventional biomechanical techniques can be applied. However, the failure rate (premature loss of OBA) of 8.6% is considered high, and has necessitated changes in the hardware and protocol.

PMID: 16170058 [PubMed - indexed for MEDLINE]

The diary of an orthognathic patient aged 30 3/4.

J Orthod. 2005 Sep;32(3):169-74

Authors: Murphy TC

This article reports on the experiences of an orthodontist who has actually undergone combined orthodontic and orthognathic treatment. The aim is to give the reader an insight into not only what we, the orthodontists, fail to tell our orthognathic patients, but also what they fail to tell us.

PMID: 16170057 [PubMed - indexed for MEDLINE]

Anterior esthetic gingival depigmentation and crown lengthening: report of a case.

J Contemp Dent Pract. 2005 Aug 15;6(3):139-47

Authors: Roshna T, Nandakumar K

Excessive gingival display space and gingival hyperpigmentation are major concerns for a large number of patients visiting the dentist. Melanin hyperpigmentation usually does not present a medical problem, but patients usually complain of dark gums as unaesthetic. This problem is aggravated in patients with a "gummy smile" or excessive gingival display while smiling. Esthetic periodontal plastic surgery is especially rewarding in such individuals with compromised esthetics. A case is reported here on the cosmetic correction of "black gums" and "gummy smile." Periodontal plastic surgery combining gingival depigmentation and esthetic crown lengthening was performed in a single appointment using scalpel surgical technique. The outline of steps involved in the surgical procedure is demonstrated and a brief review of the various gingival depigmentation techniques is depicted here.

PMID: 16127483 [PubMed - indexed for MEDLINE]